Werner Forssmann's self-surgery breakthrough
The procedure pioneered by Werner Forssmann has probably saved the life of someone you know. Every year, millions of people undergo cardiac catheterisation. It is the standard way to look at how the heart is functioning after a heart attack, chest pain or other indications of a heart problem. A description of the procedure is enough to make you wince: a small cut is made in an artery – often near the groin – and a tube is pushed in, all the way to the heart. It’s certainly not the kind of thing you would want to do to yourself.
Forssmann’s story began in 1929, when he saw drawings that showed veterinarians accessing a horse’s heart via its jugular vein. At the time, the heart was off-limits. Expose it, even touch it, received wisdom said, and a patient would surely die. It was a sensible view: we now know that the touch of a foreign body on the lining of the heart wall can disrupt the cardiac rhythms, causing instant death. But Forssmann was frustrated by the impasse. Little was known of how the heart worked – or of what could go wrong with it. He reasoned that if you could somehow get access to the heart via a vein, then we might learn at least something of its workings. Perhaps we could even use a tube to deliver drugs or fluids directly to the heart.
Forssmann may have had the idea, but he did not have the authority. He was an intern in a small hospital in Eberswalde, 30 miles north-east of Berlin. He approached his boss, the surgeon Richard Schneider, and suggested that the technique might be tried out on dying patients. Schneider said no. Forssmann even volunteered to be the subject. Schneider was having none of it, and forbade any such experiment.
What happened next shows just how anarchic – perhaps ‘subversive’ is a better word here – a scientist can be. Forssmann knew that the experiment would require sterile surgical equipment that was kept locked in the operating theatre. He tracked down someone who had the key, and proceeded to charm them into submission. Chief nurse Gerda Ditzen didn’t stand a chance.
‘I started to prowl around Gerda like a sweet-toothed cat around the cream jug.’ That was how Forssmann described his first move in the astonishing sequence of events that led to his Nobel Prize. Ditzen was passionate about medicine, and Forssmann exploited her passion: he plied her with textbooks, he talked about surgery with her for hours on end, and eventually, when he thought the time was right, he mentioned the experiment he longed to do. Ditzen eventually agreed to give him access to the necessary equipment – and to her own body as the first experimental subject.
One evening, after the theatre had closed, the pair embarked on their forbidden quest. Forssmann loosely tied Ditzen’s arms and legs to the operating table. Then he rubbed her arm, where they’d agreed to make the incision, with iodine to make it sterile. Then he disappeared. Ditzen waited for him to return – somewhat nervously, it can be imagined – but he didn’t come back. Access to the equipment was all Forssmann had wanted: he had no intention of putting Ditzen’s life at risk. Out of her sight, he made a cut in his own brachial vein and catheterised himself, pushing a length of narrow rubber tubing through the vein, up towards his heart.
The procedure produced a ‘burning sensation’, he said. Once the tube had reached his shoulder, Forssmann went back to Ditzen and showed her what he had done. She was furious at his deception, but he calmed her down and asked her to help him down the stairs to the X-ray department. Now Forssmann could watch the progress of the tube as he pushed it towards his heart. Nurse Ditzen held up a mirror so he could see what he was doing.
The radiography technician had slipped out of the room, and now he returned with Dr Peter Romeis, one of Forssmann’s colleagues. Romeis’s first reaction was to attempt to remove the catheter. Forssmann resisted the attempt by kicking Romeis hard in the shins. Eventually, and suffering more pain than the man with the rubber tube in his right auricle, Romeis relented. The catheter had reached the heart; there was nothing to be lost now by taking the X-ray picture as proof of this medical milestone.
- FREE RADICALS, Michael Brooks